991-68 Potential Impact of Serial Drug Testing on the Clinical Outcome of Survivors of Cardiac Arrest, as Assessed in the Propafenone Arm of CASH Trial

Abstract

The study design of the Cardiac Arrest Study Hamburg (CASH) trial allows retrospective assessment of serial drug testing (SDT) predictive value. Regardless of pts assignment to one of the 3 drug arms (propafenone (P), metoprolol and amiodarone) all pts undergo programmed electrical stimulation (PES) before and after oral drug administration; the assigned drug is then administered regardless of the response to SDT. Disclosure of data on P and ICD in survivors of cardiac arrest after premature termination of the former arm allowed retrospective assessment of the predictive value of SDT. In the P arm, age was 57 ± 13 yrs; 46 (79%) out of 58 pts had ischemic heart disease. During baseline PES, a sustained ventricular arrhythmia (sVA) could be induced in 25 (63%) pts assigned to P. After oral P(300–900 mg/day), 13(52%) among inducible, but 22 (67%) among noninducible pts at baseline presented a sVA in response to PES. During a median follow-up of 11 months, sVA or sudden death occurred in 2/13 (15%) nonresponders, 2/5(40%) responders, in 2/7 (29%) pts who became inducible after P and in 3/22 (14%) who were not inducible during baseline and after P. The second PES could not be performed in 11 (19%) pts due to the occurrence of spontaneous VA arrhythmias after P administration; sVA during follow-up were documented in 5 (45%) such pts. The positive and the negative predictive values of SDT with P were 60% and 15%, respectively. Data from this study suggest that, in survivors of cardiac arrest, SDT with P carries a poor predictive value to guide drug therapy. This observation prompts further investigation to assess the utility of SDT as a strategy in pts at risk of sudden death.